J. Esquivel et Ph. Sugarbaker, Second-look surgery in patients with peritoneal dissemination from appendiceal malignancy: Analysis of prognostic factors in 98 patients, ANN SURG, 234(2), 2001, pp. 198-205
Objective
To establish selection criteria for reoperation in patients with peritoneal
dissemination from appendiceal malignancy.
Summary Background Data
The outcome of patients with mucinous appendiceal neoplasms with peritoneal
surface dissemination has changed as a result of a better understanding of
the clinical and pathologic features of this disease. This knowledge, comb
ined with aggressive strategies for the use of perioperative intraperitonea
l chemotherapy and peritonectomy procedures, has resulted in long-term dise
ase-free survival in many of these patients. However, some of the patients
develop progressive disease, and a question regarding additional surgery is
appropriate. A critical analysis of the results of second-look surgery sho
uld assist in the management of patients with recurrent peritoneal surface
dissemination of an appendiceal neoplasm.
Methods
Three hundred twenty-one patients with epithelial peritoneal surface malign
ancy of appendiceal origin underwent surgery during a 12-year period. Ninet
y-eight of these patients (30.5%) underwent a second-look procedure. A data
base of selected clinical features regarding these 98 patients was gathered
from the clinical records. A critical statistical analysis of these clinic
al features and their prognostic impact was performed using survival as an
endpoint. All patients were managed by a treatment regimen that used cytore
ductive surgery and intraperitoneal chemotherapy.
Results
The overall 5-year survival rate of these 98 patients was 73.6%. This compa
red favorably with a 68% survival rate of 223 patients who did not undergo
reoperation. Survival based on the number of cytoreductive surgeries and th
e free Interval between them showed no significant difference. Patients who
had second-look surgery with bowel obstruction as a symptom and those in w
hom the amount of tumor was increased or minimally decreased at the first a
nd second cytoreductions had a significantly inferior 5-year survival rate.
A complete second cytoreduction was associated with an improved 5-year sur
vival rate.
Conclusions
Follow-up of patients treated for peritoneal dissemination from neoplasms o
f appendiceal origin is indicated. Selected patents in whom recurrence deve
lops are candidates for repeat cytoreductive surgery plus intraperitoneal c
hemotherapy with curative intent.